Effect of Clinical Pharmacist Intervention on Hemoglobin A1C Reduction in Veteran Patients With Type 2 Diabetes in a Rural Setting.

BACKGROUND: Type 2 diabetes mellitus (T2DM), if left uncontrolled, is associated with significant morbidity and mortality. Patients in rural areas may not have access to adequate resources to successfully treat diabetes. Clinical pharmacists may be utilized to bridge this gap. OBJECTIVE: To evaluate the impact of a clinical pharmacist on glycemic control in veterans with T2DM enrolled in a rural, outpatient clinic. METHODS: Retrospective chart review was performed on veterans with T2DM referred to the pharmacist-managed therapeutic monitoring clinic at a community-based outpatient clinic located in rural Jackson, TN. Patients served as their own controls. Patients with hemoglobin A1C (A1C) ≥8% were included. The primary outcome was A1C change from baseline in patients managed by the clinical pharmacist. Secondary end points included blood pressure, cholesterol, and weight. RESULTS: Of 111 veterans identified as having a A1C ≥8% in the pharmacist-managed clinic, 86 met inclusion criteria. At baseline, mean ± SD A1C was 10.5% ± 2.0% (range = 8.7%-16.2%). By the end of the intervention period, mean A1C had decreased by 2.8 percentage points to 7.7% ± 1.4% (P < 0.001). At the end of the intervention, 34% (n = 29) had a A1C of <7%, 40% (n = 34) between 7% and 7.9%, and only 6% (n = 5) >10% (P < 0.001). Improvements in diastolic blood pressure (P = 0.001), total cholesterol (P = 0.001), and triglyceride levels (P = 0.036) were also statistically significant when baseline and intervention period values were compared. CONCLUSION: Pharmacist interventions at a rural, outpatient clinic had a statistically significant impact on A1C reduction in veterans with T2DM.

Comparison of clinical pharmacy specialists and primary care physicians in treatment of type 2 diabetes mellitus in rural Veterans Affairs facilities.

PURPOSE: Results of a study to compare the impact of clinical pharmacy specialist (CPS) interventions with primary care physician (PCP) interventions in veterans with type 2 diabetes mellitus (T2D) in a rural setting are presented. METHODS: A retrospective analysis was performed examining veterans diagnosed with T2D with a glycosylated hemoglobin (HbA1c) of ≥8% receiving treatment at a rural community-based outpatient clinic associated with the Memphis Veterans Affairs Medical Center. Propensity score matching was used to create a 1:1 cohort of patients managed by physicians or clinical pharmacy specialists. Patients were evaluated as their own control and as compared cohorts. The primary outcome was the difference in HbA1c. Secondary outcomes included changes in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and body mass index. RESULTS: Data were collected from 124 patients (n = 62 CPS patients, n = 62 PCP patients). Baseline HbA1c in the CPS and PCP groups were 10.2% ± 1.9% and 9.6% ± 1.6%, respectively. Postintervention HbA1c in the CPS cohort was 7.5% ± 1.1% (range, 6-11.7%), indicating an absolute reduction of 2.7% (p < 0.001). Postintervention HbA1c in the PCP cohort was 8.5% ± 1.5% (range, 5.4-12.6%), resulting in an absolute reduction of 1.1% (p < 0.001). The CPS intervention resulted in a greater mean HbA1c absolute reduction of 1.6 percentage points compared to physician intervention (p < 0.001). CONCLUSION: Compared with physician intervention, clinical pharmacy intervention in the treatment of T2D led to a greater mean HbA1c reduction in patients receiving care through VA facilities in rural settings.